ABOUT 'BEAT YOUR A-FIB'...


"This book is incredibly complete and easy-to-understand for anybody. I certainly recommend it for patients who want to know more about atrial fibrillation than what they will learn from doctors...."

Pierre Jaïs, M.D. Professor of Cardiology, Haut-Lévêque Hospital, Bordeaux, France

"Dear Steve, I saw a patient this morning with your book [in hand] and highlights throughout. She loves it and finds it very useful to help her in dealing with atrial fibrillation."

Dr. Wilber Su Cavanaugh Heart Center, Phoenix, AZ

"Your book [Beat Your A-Fib] is the quintessential most important guide not only for the individual experiencing atrial fibrillation and his family, but also for primary physicians, and cardiologists."

Jane-Alexandra Krehbiel, nurse, blogger and author "Rational Preparedness: A Primer to Preparedness"



ABOUT A-FIB.COM...


"Steve Ryan's summaries of the Boston A-Fib Symposium are terrific. Steve has the ability to synthesize and communicate accurately in clear and simple terms the essence of complex subjects. This is an exceptional skill and a great service to patients with atrial fibrillation."

Dr. Jeremy Ruskin of Mass. General Hospital and Harvard Medical School

"I love your [A-fib.com] website, Patti and Steve! An excellent resource for anybody seeking credible science on atrial fibrillation plus compelling real-life stories from others living with A-Fib. Congratulations…"

Carolyn Thomas, blogger and heart attack survivor; MyHeartSisters.org

"Steve, your website was so helpful. Thank you! After two ablations I am now A-fib free. You are a great help to a lot of people, keep up the good work."

Terry Traver, former A-Fib patient

"If you want to do some research on AF go to A-Fib.com by Steve Ryan, this site was a big help to me, and helped me be free of AF."

Roy Salmon Patient, A-Fib Free; pacemakerclub.com, Sept. 2013


Catheter Ablation

Live Case: Non-Contact Ultrasound Basket Catheter Dipole Density Mapping

2017 AF Symposium

Live Case: Ablation Using Non-Contact Ultrasound Basket Catheter Dipole Density Mapping

Illlustration: Acutus Medical Non-Contact Dipole basket catheter with multiple electrodes.

Acutus Medical Non-Contact Dipole basket catheter with multiple electrodes.

Video streaming of an ablation from Na Homolce Hospital in Prague, the Czech Republic with Drs. Peter Neuzil, Jan Petru, and Jan Skoda.

The doctors used a new high resolution mapping system from Acutus Medical to identify in real time where his A-Fib signals were coming from.

Patient background: A 68-year-old man in paroxysmal A-Fib had a CHA2DS2-VASc score of 4 with hypertension and a pulmonary embolism. He had had a PVI in January 2011 and a repeat PVI to fix gaps in April 2011. His A-Fib recurred in 2014. Electrical cardioversions didn’t work.

Non-Contact Mapping with Ultrasound-Electrode Catheter

VIDEO: For more a detailed explanation of the Non-Contact Dipole Density AcQ Imaging and Mapping, see the video from Actus Medical.(1:54)

The Acutus Medical Non-Contact Dipole Density AcQ Imaging and Mapping catheter uses a basket catheter with multiple electrodes and ultrasound anatomy reconstruction.

‘Non-contact’ means the basket catheter can float freely in the left atrium and doesn’t have to be applied to the surface of the heart to generate A-Fib maps.

The basket catheter has six splines each with eight nodules that contain 48 ultrasound transducers and 48 electrodes. The ultrasound pings the atrium wall and rapidly produces a 3D left atrium anatomy.

Electrical Measurement: Dipole Density vs Voltage

For over one hundred years, voltage has been the major electrical measurement in cardiac medicine. The limitation with using voltage in electrophysiology is that the reading includes both the localized charge (Dipole Density) as well as the sum of the surrounding sources providing a broad, blended view of cardiac activity.

According to Acutus Medical, by eliminating these surrounding sources, and using dipole density (instead of voltage) the field of view becomes sharper and narrower.

This more precise electrical activation is displayed as a Dipole Density map on a 3D ultrasound reconstruction of the heart.

Acutus Medical Illustration: localized charge (Dipole Density) with the sum of the surrounding sources

Acutus Medical Illustration: localized charge (Dipole Density) with the sum of the surrounding sources

Live Streaming Video: Ablation from Prague

In the live case, the EPs used the non-contact basket catheter to generate a 3D anatomy of the patient’s left atrium.

They produced propagation maps which looked like rotor action seen in other mapping systems, but sharper and with high resolution.

During the ablation, they used the basket catheter to re-map the left atrium. This showed that there were gaps in the ablation of one of the right vein openings which they corrected.

What Patients Need To Know

May Replace Contact Mapping: Non-contact mapping is a significant innovation in catheter ablation and may eventually replace existing contact mapping catheters and make ablations easier. It also seems to require less technical skill than in a traditional contact mapping system.

“Non-contact mapping is a significant innovation and may eventually replace existing contact mapping catheters.”—Steve Ryan

No Radiation & Instantaneous: Using ultrasound to produce a 3D rendering of the heart is innovative and could change the way the anatomy of the heart is generated for an ablation. And unlike a CT scan, it doesn’t use radiation. Also, unlike a CT scan, the ultrasound images of the heart are generated instantaneously in real-time.

Higher Resolution: Dipole Density mapping may prove to be a higher resolution system than current mapping systems.

Not Yet Available in U.S.: But don’t expect the Acutus Medical System to become available in the U.S. any time soon. It isn’t yet FDA approved or available for sale in the U.S.

Return to 2017 AF Symposium Reports
If you find any errors on this page, email us. Last updated: Thursday, February 23, 2017

Reference for this Article

2017 AF Symposium: Three New Reports—Genetic A-Fib and LIVE Streaming Video Ablations

Live Streaming Video from AF Symposium at A-Fib.com

To my 2017 AF Symposium Overview, I added how we observed in-progress A-Fib procedures via streaming video from five locations spanning the globe, and heard from the EPs performing the ablations. Continue to the Video Overview…

Report 11: LIVE! Ablation Using CardioFocus Laser Balloon

CardioFocus HeartLight Laser Balloon catheter

CardioFocus HeartLight Laser Balloon catheter

Video streaming from Na Homolce Hospital in Prague, The Czech Republic. Drs. Peter Neuzil, Jan Petru and Jan Skoda did an ablation using the CardioFocus HeartLight Endoscopic Visually Guided Laser Balloon (FDA approved April 4, 2016).

The doctors showed how they could directly see the Pulmonary Vein opening they were ablating (unlike RF and CryoBalloon systems). The center of the catheter has an endoscopic (looking inside) camera.

(To me, this is a major advantage and ground-breaking improvement for patients.)

Read more of my report, and see a short video clip with an actual view of the pulmonary veins during an ablation. …Continue reading my report….

Report 10: LIVE! Two Procedures—but Different Left Atrial Appendage Occlusion Devices

Featuring the Amplatz Amulet from St. Jude Medical and the LAmbre from LifeTech Scientific.

Amplatz Amulet occlusion device by St. Jude Medical - A-Fib.com

Amplatz Amulet occlusion device by St. Jude Medical

Live from Milan, we watched the doctors insert an Amplatz Amulet into the LAA of a 78-year-old women who had a high risk of bleeding.

These doctors did something I had never seen before. They made a physical model of the woman’s LAA, then showed how the Amplatz Amulet fit into the model. This helped AF Symposium attendees see how the Amplatz Amulet actually worked. …Continue reading my report…

Report 9: World-Wide Studies on Genetic A-Fib

DNA: Double helix graphic at A-Fib.com

Dr. Patrick Ellinor of Mass. General Hospital, Boston MA, reported the biggest news is that A-Fib genetic research is increasing exponentially. The AFGen Consortium website lists 37 different studies and world-wide institutions studying A-Fib genetics with over 70,000 cases. Within the next 10 years, Dr. Ellinor and his colleagues hope to identify over 100 different genetic loci for A-Fib.

Dr. Ellinor reported that using a genetic “fingerprint” of A-Fib helps to identify those patients at the greatest risk of a stroke. (There’s a 40% increased risk of developing A-Fib if a relative has it.)…Continue reading my report…

About the Annual AF Symposium

The annual AF Symposium brings together the world’s leading medical scientists, researchers and EPs to share recent advances in the treatment of atrial fibrillation. You can read all my summary reports on my 2017 AF Symposium page.

Video: A Live Case of Catheter Ablation for Long-Standing Persistent A-Fib Through 3D Mapping & ECG Images

Presented entirely through 3D mapping and ECG images, a live demo of ablation for long-standing, persistent A-Fib is followed from start to finish. Titles identify each step. No narration, music track only (I turned down the volume as the music track was distracting.)

3D mapping and ECG images show the technique of transseptal access, 3D mapping, PV isolation, and ablating additional drivers of AF in the posterior wall and left atrial appendage. (8:03) Produced by Dr. James Ong, Heart Rhythm Specialist of Southern California.

NOTE: Before viewing this video, you should already have some basic understanding of cardiac anatomy and A-Fib physiology.


YouTube video playback controls:
 
When watching this video, you have several playback options. The following controls are located in the lower right portion of the frame: Turn on closed captions, Settings (speed/quality), Watch on YouTube website, and Enlarge video to full frame. Click an icon to select.

If you find any errors on this page, email us. Y Last updated: Sunday, February 19, 2017 Return to Instructional A-Fib Videos and Animations

Video: When Drug Therapy Fails: Why Patients Consider Catheter Ablation

For Insidermedicine.com. Dr. Susan M. Sharma discusses why patients with atrial fibrillation turn to ablation when drug therapy doesn’t work. Presenting research findings by David J. Wilber and MD; Carlo Pappone, MD, Dr. Sharma discusses the success rates of drug therapy versus catheter ablation. (See transcript below.) (3:00 min.) Published Jan. 26, 2010 on Insidermedicine.com.

 

Transcript of this video
Research Reference for this Video

If you find any errors on this page, email us. Y Last updated: Sunday, February 19, 2017

Return to Instructional A-Fib Videos and Animations

Catheter Ablation For A-Fib: What it is, How it’s Done and What Results Can Be Expected

Dr. Patrick Tchou and Dr. Bryan Baranowski, cardiologists from the Cleveland Clinic describe the catheter ablation procedure for the treatment of atrial fibrillation (A-Fib), what it is, how it’s done and what results can be expected from this surgery.

Excellent animations: showing A-Fib’s chaotic signals, and the pattern of ablation scars around the openings to the pulmonary veins. By the Cleveland Clinic (4:00 min.)

YouTube video playback controls: When watching this video, you have several playback options. The following controls are located in the lower right portion of the frame: Turn on closed captions, Settings (speed/quality), Watch on YouTube website, and Enlarge video to full frame. Click an icon to select. 

If you find any errors on this page, email us. Y Last updated: Sunday, February 19, 2017

Return to Instructional A-Fib Videos and Animations

Video: Inside the EP Lab with Dr. James Ong: Using Mapping & CT Scan Technologies During a Pulmonary Vein Isolation

Cardiac Electrophysiologist Dr. James Ong begins with a brief tour of the EP lab and control room; Dr. Ong explains how pulmonary vein isolation is done with radiofrequency ablation to cure atrial fibrillation.

Included are: Mapping technology; the Virtual Geometrical shell of the heart displayed next to the CT scan; Placement of the catheter, real time tracking; the Complex Fractionated Electrogram (CFE) Map used to identify and eliminate the extra drivers (aside from the pulmonary veins). (6:01) From a series of videos by Dr. Ong, Heart Rhythm Specialists of Southern California.

YouTube video playback controls: When watching this video, you have several playback options. The following controls are located in the lower right portion of the frame: Turn on closed captions, Settings (speed/quality), Watch on YouTube website, and Enlarge video to full frame. Click an icon to select.


If you find any errors on this page, 
email us. Y Last updated: Saturday, February 18, 2017

Return to Instructional A-Fib Videos and Animations

2017 AF Symposium Video Streaming: Ablation using CardioFocus Laser Balloon

2017 AF Symposium

Live Case: Ablation using CardioFocus Laser Balloon

Video clip: :16 sec view of pulmonary view opening during ablation with HeartLight System; from ‘Ablate What You See & See What You Ablate’.

Video streaming from Na Homolce Hospital in Prague, The Czech Republic. Drs. Peter Neuzil, Jan Petru and Jan Skoda, in their second live case, did an ablation using the CardioFocus HeartLight Endoscopic Visually Guided Laser Balloon (FDA approved April 4, 2016).

Direct Visualization

The doctors showed how they could directly see the Pulmonary Vein opening they were ablating (unlike RF and CryoBalloon systems).

The center of the catheter has an endoscopic (looking inside) camera. (To me, this is a major advantage and ground-breaking improvement for patients.) (Watch :13 video clip)

Laser Energy For Ablation

CardioFocus HeartLight Laser Balloon at A-Fib.com

CardioFocus HeartLight Laser Balloon

In the center of the catheter is an optical fiber which produces an arc of laser (near infrared) energy. When they applied this laser energy, it looked like a green flashing light that circled the PV.

The doctors said that watching this circulating green arc allowed them to visually see if they were making complete circular lesions of the PV.

They later used a regular Lasso catheter to check for ablation integrity.

Variable Diameter Compliant Balloon

The doctors also showed how the CardioFocus HeartLight system uses a variable diameter compliant balloon which can be sized to fit into a wide range of PV openings.

See our library of videos about Atrial Fibrillation

One preliminary research article suggested that the Laser Balloon system clinical outcomes were an improvement over CryoBalloon ablation. 

VIDEO ANIMATION: For a one-minute animation of how the CardioFocus HeartLight system works, see Visually Guided Ablation.

Editor’s Comments:
The CardioFocus HeartLight Laser Balloon catheter seems like a major advance in the treatment of A-Fib, To be able to look directly at the PV opening instead of using fluoroscopy, etc. should make an EP’s ablation task much easier and potentially more effective. And having a variable diameter compliant balloon is an added plus.
But when I talked with the CardioFocus rep at the AF Symposium exhibit hall, he said they were in the process of rolling out the Laser Balloon system to various centers. It may be a short while till the system is up and operational nationwide in the U.S. (It’s already in use in Europe.) We will try to list which centers use the Laser Balloon system.
If real world experience proves its effectiveness, the CardioFocus HeartLight Laser Balloon system may eventually make CryoBalloon ablation a secondary player.

Return to 2017 AF Symposium Reports
If you find any errors on this page, email us. Last updated: Sunday, February 12, 2017

Resources for this article

FAQs A-Fib Treatments: Catheter Ablation Procedures

Catheter ablation illustration at A-Fib.com

Catheter ablation

Atrial Fibrillation patients seeking a cure and relief from their symptoms often have many questions about catheter ablation procedures. Here are answers to the most frequently asked questions by patients and their families. (Click on the question to jump to the answer)

1. Heart Function: “Does this burning and scarring during the ablation procedure affect how the heart functions? Should athletes, for example, be concerned that their heart won’t function as well after an ablation?”

Related question: “I’m a life-long runner. I recently got intermittent A-Fib. Does ablation (whether RF or Cryo) affect the heart’s blood pumping output potential because of the destruction of cardiac tissue? And if so, how much? One doc said it does.”

2. Radiation: “How dangerous is the fluoroscopy radiation during an ablation? I know I need a Pulmonary Vein Ablation (Isolation) procedure to stop my A-Fib—A-Fib destroys my life. I’m worried about radiation exposure.”

3. Condition of Heart: “What is an enlarged heart? Does it cause A-Fib? I was told I can’t have a catheter ablation because I have an enlarged heart. Why is that?”

Related question: I have serious heart problems and chronic heart disease along with Atrial Fibrillation. Would a Pulmonary Vein Ablation help me? Should I get one?”

Related question:  I have a defective Mitral Valve. Is it causing my A-Fib? Should I have my Mitral Valve fixed first before I have a PVA?”

4. Age: “I am 82 years old. Am I too old to have a successful Pulmonary Vein Ablation? What doctors or medical centers perform PVAs on patients my age?”

Related question:I’m 80 and have been in Chronic (persistent/permanent) A-Fib for 3 years. I actually feel somewhat better now than when I had occasional (Paroxysmal) A-Fib. Is it worth trying to get an ablation?

5. Blanking Period: “How long before you know a Pulmonary Vein Ablation procedure is a success? I just had a PVA(I). I’ve got bruising on my leg, my chest hurts, and I have a fever at night. I still don’t feel quite right. Is this normal?”

Related question: Since my ablation, my A-Fib feels worse and is more frequent than before, though I do seem to be improving each week. My doctor said I shouldn’t worry, that this is normal. Is my ablation a failure?”

6. O.R. Report: I want to read exactly what was done during my Pulmonary Vein Ablation. Where can I get the specifics? What records are kept?”

7. Procedure Length: “What is the typical length of a catheter ablation today versus when you had your catheter ablation in 1998 in Bordeaux, France? What makes it possible?”

8. Clots/Blood Thinners: “After my successful Pulmonary Vein Ablation, do I still need to be on blood thinners like Coumadin, an NOAC or aspirin?”

Related question:I was told that I will have to take an anticoagulant for about 2-3 months after my ablation. Afterwards shouldn’t there be even less need for a prescription anticoagulant rather than more?”

Related question: During an ablation, how much danger is there of developing a clot? What are the odds? How can these clots be prevented?”

9. Exercise: “I’m having a PVA and I love to exercise. Everything I read says ‘You can resume normal activity in a few days.’ Can I return to what’s ‘normal’ exercise for me?”

10. Non-PV Triggers: “Are there other areas besides the pulmonary veins with the potential to turn into A-Fib hot spots? I had a successful catheter ablation and feel great. Could they eventually be turned on and put me back into A-Fib?

11. Heart Rate: “I’m six months post CryoBalloon ablation and very pleased. But my resting heart rate remains higher in the low 80s. Why? I’ve been told it’s not a problem. I’m 64 and exercise okay, but I’ve had to drop interval training.”

12. The Bordeaux Group: “I’ve heard good things about the French Bordeaux group. Didn’t Prof. Michel Häissaguerre invent catheter ablation for A-Fib? Where can I get more info about them? How much does it cost to go there?”

13. Cure? “I have Chronic Atrial Fibrillation. Am I a candidate for a Pulmonary Vein Ablation? Will it cure me? What are my chances of being cured compared to someone with Paroxysmal (occasional) A-Fib?”

Related question: I’ve read that an ablation only treats A-Fib symptoms, that it isn’t a ‘cure’. If I take meds like flecainide which stop all A-Fib symptoms and have no significant side effects, isn’t that a ‘cure?’”

14. Tech Advances: “I’m getting by with my Atrial Fibrillation. With the recent improvements in Pulmonary Vein ablation techniques, should I wait until a better technique is developed?”

If you find any errors on this page, email us. Y Last updated: Tuesday, February 14, 2017
Return to Frequently Asked Questions

FAQs: Does Ablation Treat Symptoms or “Cure” Atrial Fibrillation?

Catheter Ablation

FAQs A-Fib Ablations: Is it a Cure?

“I’ve read that an ablation only treats A-Fib symptoms, that it isn’t a “cure.” If I take meds like flecainide which stop all A-Fib symptoms and have no significant side effects, isn’t that a ‘cure?’”

A successful catheter ablation doesn’t just treat A-Fib symptoms, it physically changes your heart.

Isolates PVs: An ablation closes off the openings around your pulmonary veins (PVs) so A-Fib signals from the Pulmonary Veins (PVs) can no longer get into your heart. It electrically ‘isolates’ your PVs. If successful and permanent, you should be protected from developing A-Fib that originates from your PVs (where most A-Fib originates).

Recurrence Rates: Older research showed that recurrence of A-Fib after an ablation occurred at a 7% rate out to five years. But this was before the use of the newer techniques of Contact Force Sensing catheters and CryoBalloon ablation which make more permanent lesion lines around your Pulmonary Veins.

Also, people with comorbidities, like sleep apnea, obesity, diabetes, hypertension, tend to have more recurrences. Sleep apnea can cause A-Fib to develop in other parts of the heart besides the Pulmonary Veins.

Worst case scenario: But let’s discuss a worst case scenario after a successful catheter ablation. Let’s say that five years later, your A-Fib reoccurs. Usually, all that’s necessary is for a touch-up ablation to fix some gaps in the isolation burns around the openings to the PVs or other spots. It’s usually a much easier, faster procedure than your original ablation. Often, that’s all that’s necessary to keep you A-Fib free.

No Magic Pill for A-Fib: In more than 40% of cases, antiarrhythmic drugs don’t work, cause bad side effects, or lose their effectiveness over time. We don’t currently have a magic pill you can take which will guarantee to forever cure you of A-Fib.

I’m glad that flecainide works for you, but it’s not generally considered a permanent cure for A-Fib.

Catheter Ablation Only Hope of a “Cure”: The bottom line is that catheter ablation (and some surgeries) currently offers the only hope of a permanent cure of A-Fib. That doesn’t mean that all A-Fib ablations are 100% successful. Catheter ablation is a relatively new field where there is still a lot to learn. But catheter ablation is a low-risk procedure with a high rate of success. Right now, it’s the best that medical science has to offer to fix Atrial Fibrillation.

Return to FAQ Catheter Ablations

Finally in Sinus Rhythm After 4 Years in Chronic Asymptomatic Atrial Fibrillation

Roger Finnern, personal A-Fib story at A-Fib.com

Roger Finnern

A-Fib Patient Story #94

Finally in Sinus Rhythm After 4 Years in Chronic Asymptomatic Atrial Fibrillation

By Roger Finnern, Tempe, AZ, February 2017

Steve, I had to let you know how thankful I am for all your recommendations and help over the past year. Feel free to use the following on your website or whatever, to give hope to others going through the process.

My Atrial Fibrillation: I was Told to “Just Live with It.”

I contacted you last in December 2015 as I was in chronic A-Fib without symptoms, age 67, and  I had a cardiologist who wanted me to do nothing but take a low dose aspirin and live with it.

My cardiologist wanted me to do nothing [about my A-Fib] but take a low dose aspirin and live with it.

After two years of being in Chronic A-Fib, I went out on my own. With your recommendation, I contacted Dr. Vijay Swarup, Arizona Heart Rhythm Center. I ended up getting a RF ablation in early February 2016.

After Ablation, Back in A-Fib

After my ablation, I was in rhythm only 2 days before it reverted. They performed cardioversion twice before releasing me from the hospital, and each worked only for a minute before reverting back.

Dr. Swarup was a bit miffed as he had tested all ablated points and could not produce any response back to A-fib. He said something to the effect that my heart was highly irritated. They put me on the antiarrhythmic drug amiodarone to convert at home.

Amiodarone Works—Finally in Sinus After 4 Years!

The amiodarone worked, and one week later I saw my doctor and had my first normal EKG since 2013!

One week later I saw my doctor and had my first normal EKG since 2013!

On August 2, six months post-ablation, I was taken off amiodarone. (I was kept on amiodarone longer than normal, due to the rough time we had getting into rhythm initially.)

Being on amiodarone over a long period, I was fortunate that I seemed to not have bad side effects. But I did notice after being off it for a while, that I breathed easier.

Need a Blood Thinner If In Normal Sinus Rhythm?

I was maintaining normal rhythm, so during my October 25, 2016 appointment, I asked Dr. Swarup about getting off the blood thinner Eliquis. .

..he ordered a TEE to check the strength, shape, etc. of my left atrial appendage.

So he ordered a Transesophageal Echocardiogram (TEE) to check the strength, shape, etc. of my left atrial appendage (LAA). From that we could also determine if Eliquis or the Watchman occlusion device would otherwise be feasible. [If blood isn’t being pumped out properly from the LAA, there is more risk of clots forming and stroke, even if one is in sinus rhythm.]

My LAA pumping velocity was good. Dr. Swarup has taken me off Eliquis, so things have turned out exceptionally well for me.

I had been taking 1 gram of krill oil with the Eliquis. Now that I am off Eliquis, I have decided to double it for now just in case―strictly a personal choice.

Sleep Apnea Study―Philips DreamWear Mask

During the last nine months [post-ablation] I wore a heart monitor [e.g. halter or event monitor] for a 10 day period.

I also did a sleep study at home―required by Dr. Swarup. They furnish the equipment, and it is fairly easy to do. I turned out to have mild sleep apnea.

I did a sleep study at home and I turned out to have mild sleep apnea.

I have been on a CPAP [Continuous positive airway pressure] machine for the past two months. My episode numbers reduced considerably, so they are happy with the results.

Probably like everyone else, I did not think I could handle the mask, but it has turned out just fine. I highly recommend the DreamWear mask by Philips as it is very comfortable, only one strap, and a pillow type cushion under the nose. I barely know I am wearing a mask.

I have also travelled through airports with the machine in a provided carry-on case and have had no problems whatsoever. It also does not count toward your carry on limit as it is a medical device.

Acupuncture Helps

Throughout my process, I went to a highly experienced acupuncturist about once every week and I will probably continue to do this forever.

This opened up the field of eastern medicine to me, which I now have a healthy respect for.

Steve, she was well aware of the heart points you had in an article on the website way back and had a few others of her own. [See my article: Acupuncture Helps A-Fib: Specific Acupuncture Sites Identified.)

While those points were used by doctors to maintain rhythm after an ablation, I tried them before the ablation just to see if they might work anyway. This opened up the field of eastern medicine to me, which I now have a healthy respect for. I think there is definitely something to this, as it seems to have such a calming effect.

I Feel Fantastic!―But I know This is a Process

Who knows what the future brings, but I feel fantastic and wanted to let you know, Steve, how grateful I am to you for your guidance.

Dr. Swarup says this is a process…we got the rhythm back and now the job is to keep it.

Lessons Learned

Recognize that Tiredness May Be a Symptom of A-Fib: My A-Fib first showed up on a routine physical. Looking back, other than some tiredness, I hadn’t noticed any thing unusual up to that point. Since I stay in good shape, hiking, biking, golf, and some high intensity interval exercises, I had just attributed the tiredness to getting older and just kept on going.

I Waited Longer Than I Should Have: The EKG in April, 2014 which showed that I had A-Fib really shocked me. I did my research, found your website [A-Fib.com], and learned all about magnesium and acupuncture.

In hindsight, I waited longer than I should have. But I had to find out if these natural treatments would straighten out my A-Fib condition without going through an ablation procedure.

Doubted my Cardiologist’s Advice: Also, a cardiologist told me to do nothing since I had no symptoms, though in my mind I started doubting him almost from the beginning.

Get an Ablation Sooner Rather Than Later…But May Not be Easy: My lesson learned is to plan for an ablation sooner than later.

My experience with the ablation and the required cardioversions in a three-day period in the hospital really knocked me for a loop.

And don’t think that this will necessarily be an easy procedure. Everyone is different. My experience with the ablation and the required cardioversions in a three-day period in the hospital really knocked me for a loop. Despite my relatively good physical condition, I definitely had a case of the rubber legs.

I personally recommend to anyone getting an ablation, that you should plan on taking a week or even two off work to really recover before getting back to your normal routine.

Need for Second Ablation? If I ever have to do a second ablation, I will probably go ahead. But I will have to think long and hard about what kind of symptoms I have, as well as how much older I am.

The future is just speculation. As for now, having an ablation was definitely the right decision and turned out great.

Thanks again,
Roger Finnern, Tempe, AZ

Editor’s Comments:

Amiodarone Dangerous Drug: Amiodarone is the strongest and often the most effective antiarrhythmic drug, but it’s also the most toxic. (See my post Amiodarone Effective But Toxic)
Amiodarone is used in difficult cases like Roger’s after his ablation to get his heart in the habit of beating normally, but usually only for a short period of time.
It has to be carefully monitored for bad side effects. Some say amiodarone is so toxic that it shouldn’t be used at all, even in cases like Roger’s. It’s a difficult decision. It worked for Roger, but he did notice that amiodarone affected his lungs and breathing. “After being off of it…I breathed easier.”
“No Symptom” A-Fib May Not be Accurate: Some say that there really is no such thing as Asymptomatic A-Fib, that people just get used to how A-Fib affects them and put up with it. That seems to have been the case with Roger. He writes that now being in normal sinus rhythm feels “fantastic!” and very different than being in Chronic “asymptomatic” A-Fib.
Some would say that because Roger had few noticeable symptoms and was in Chronic A-Fib for some time, that it wasn’t justified to perform a catheter ablation on him. But A-Fib is a progressive disease. See my Editorial: Leaving the Patient in A-Fib—No! No! No! for a list of damage caused by A-Fib over time.
For Roger, being A-Fib free has radically improved his health and quality of life. Even if you are “asymptomatic,” you may still want to be A-Fib free. You have a right to do so.
Blood Thinners after an Ablation? Some would say that Roger should forever be on blood thinners (especially drug companies) for continued risk of stroke, even if he is A-Fib free.
But research indicates that a successful ablation reduces the risk of stroke to that of a normal person. (See my FAQs A-Fib Ablations: Blood Thinner Post-Ablation?) Blood thinners are not like taking vitamins. They have their own risks, like causing bleeding.
A Very Difficult Case: Someone is Chronic A-Fib for a long time is usually the hardest to ablate and make A-Fib free. In addition to the Pulmonary Veins (PVs), their hearts often have many non-PV triggers which have to be carefully mapped and ablated.
Not all EPs have this level of skill and experience. Roger was fortunate to go to Dr. Vijay Swarup who seems to have made Roger A-Fib-free after only one ablation.
O.R. Operating Room Report: Roger’s OR report showed how Dr. Swarup had to work very hard to find and ablate all of Roger’s non-PV triggers. After isolating Roger’s PVs, Roger was still in atypical atrial flutter, often one of the hardest arrhythmias to find and ablate. Dr. Swarup had to make a Mitral Isthmus ablation line and a Left Atrium roof line.
Then Dr. Swarup found right atrium flutter and made a caviotricuspid isthmus line to block it.
Afterwards, when Dr. Swarup administered isoproterenol to Roger to stimulate any remaining non-PV triggers, he found a tachycardia coming from an unusual spot―the posterior-septal aspect of the tricuspid annulus. (In all the O.R. reports I’ve read, I’ve never heard of an A-Fib signal coming from this spot.) When Dr. Swarup ablated this focal site, Roger terminated into sinus rhythm. That’s the best result an EP can hope for from an ablation. Further administering of Isoproterenol couldn’t produce any other non-PV trigger sites in Roger.
If his A-Fib Returns: Roger knows that he may not be completely out of the woods yet. A second ablation will usually take care of any gaps or hidden triggers and will often be a much easier, faster ablation than the first.
And each day Roger is in normal sinus rhythm and A-Fib free makes his heart healthier, stronger and more apt to beat normally. Not to mention how much better Roger feels both physically and emotionally.

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FDA Approved: CardioInsight (ECGI) Mapping and Ablation System Now Available in U.S.

CardioInsight 3D system vest - A-Fib.com

CardioInsight 3D system vest

Medtronic’s CardioInsight Noninvasive 3D Mapping System (ECGI) has received FDA clearance for use in the U.S. The CardioInsight system is the first non-invasive mapping system in the world.

Dr. Vivek Reddy at Mount Sinai Medical Center in New York City was the first to use the system commercially in the U.S.

CardioInsight Noninvasive 3D Mapping System (ECGI)

The CardioInsight system allows physicians to locate the origin of a patient’s irregular heart rhythms (arrhythmias). Cardiac mapping is traditionally achieved by inserting a catheter into the heart via an artery or vein.

The CardioInsight 3D system instead uses a 252-electrode sensor vest to non-invasively (from outside the heart) map irregular rhythms like A-Fib. The vest is a single-use, disposable multi-electrode vest that gathers cardiac electrophysiological data from the body surface. The 3D mapping system combines these signals with CT scan data to produce and display simultaneous 3-D cardiac maps.

The vest technology contours to the patient’s body and allows for continuous and simultaneous panoramic mapping of both atria or both ventricles, which cannot be achieved with current invasive methods. The 3D cardiac maps can be created by capturing a single heartbeat, and enable rapid mapping of these heart rhythms.

VIDEO: To learn how the vest is applied to the patient, see the vest application instructional video at the Medtronic CardioInsight™ Mapping Vest webpage.

ECGI is a Major Breakthrough in Treating A-Fib

ECGI mapping is certainly one of, or even the most important new development in the treatment of A-Fib.

In 2013, I started reporting about this ECGI system. Prof. Haissaguerre and his colleagues in Bordeaux, France, were very active and instrumental in the use of the CardioInsight system. They are credited with the greatest number of presentations and publications on the system. CardioInsight expanded its rollout to eight different venues in Europe where it tested as well as it did at Bordeaux. It’s now available in the U.S.―great news for patients.

Back then, I predicted that “the ECGI system, barring unforeseen circumstances, would rapidly supersede all other mapping systems and will become the standard of care in the treatment of A-Fib patients.”

David Neth wearing ECGI vest before ablation by the Bordeaux Groups - A-Fib.com

David Neth wearing ECGI vest before ablation by the Bordeaux Group

Not only does the CardioInsight (ECGI) system produce a complete, precise, 3D, color video of each spot in a patient’s heart producing A-Fib signals, but also the video can be done by a technician before the procedure right at the patient’s bedside rather than by the  electrophysiologist (EP) during an ablation. It also can be used during the procedure, for example to re-map an ablated area.

Dr Vivek Reddy stated: This system shifts mapping away from the EP lab, potentially saving time and enhancing the patient experience.”

The CardioInsight map is a better, more accurate, more complete map than an EP can produce by using a conventional mapping catheter inside the heart.

Should You Wait on Your Ablation for ECGI Mapping?

From a patient’s perspective, CardioInsight (ECGI) reduces both the time it takes to do an ablation and the number of burns a patient receives.

The question for patients is, should you wait on having an ablation till a CardioInsight  mapping system is available at your center?

The CardioInsight mapping system is most effective in cases of persistent or long-standing persistent A-Fib.

The CardioInsight mapping system is most effective in cases of persistent or long-standing persistent A-Fib where non-PV triggers have developed. Most cases of short-duration, paroxysmal A-Fib haven’t usually developed a lot of non-PV triggers.

Hence, if you’ve only been in A-Fib for a relatively short time and are still paroxysmal, it’s probably not worth the wait.

Medtronic Rollout of CardioInsight System

Medtronic will employ a strategic rollout of the technology in the geographies where it is cleared. I will try to report when an A-Fib center in the U.S. receives a CardioInsight system..

To read more about the CardioInsight (ECGI) system, see my article, How ECGI (Non-Invasive Electrocardiographic Imaging) Works.

Disclosure: Dr Vivek Reddy consults for and receives research funding from Medtronic.

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Prayer and CyroAblation: A-Fib Free! But Now Persistent PVCs

AGL's A-Fib Story continues at A-Fib.com

AGL’s A-Fib Story continues

A-Fib Patient Story #93

Prayer and CyroAblation: A-Fib Free! But Now Persistent PVCs

By AGL, December 2016

AGL first shared his story with A-Fib.com readers in August 2016 (My A-Fib Story: The Healing Power of Prayer, #88). Here, he shares the rest of the story…up-to-date and expanded.

In early 2011, I had my first heart episode. I sat down at my desk at work and my heart rate did not slow down. I was sitting there but my heart felt like I was jogging. I thought I’d sleep it off, so I went home and took a nap.

My First A-Fib Episode

It didn’t go away.

I eventually went to the ER where they said my heart rate was 235. They used adenosine which broke the episode, and my heart rate fell to 130s–140s.

They thought I had SVT [Supraventricular tachycardia] since my heart rate was so fast.

At this point they thought I had SVT [Supraventricular tachycardia], since my heart rate was so fast. If it was A-Fib ―it was difficult to determine due to the skewed heart rate graph. Since that was my first episode, I didn’t make any changes [to prevent future episodes]. I couldn’t be sure if it was simply a fluke or not.

Not a One-Time Fluke

But after a few more episodes within a year or two, I knew this wasn’t a one-time fluke.

I went to see a cardiologist who gave me three choices of proceeding: 1) do nothing 2) take medicine or 3) have an ablation. He didn’t recommend I go with an ablation due to risks involved.

I began taking 120mg of Cardizem, but that did not help―it simply slowed my heart rate and lowered by blood pressure. I was also taking 81mg of aspirin daily [for risk of stoke].

A-Fib Confounded by Sleep Disturbance

I wasn’t making progress in my A-Fib battle―and I was sleeping terribly. For three months I woke up every night at 2:30 a.m. Then, the rest of the night’s “sleep” was sketchy. (The sleep disturbance wasn’t caused by my A-Fib.)

After I came across an article online NSAIDs―The Unintended Consequences, 

I told my cardiologist I was finished with taking Cardizem and asked how I could safely stop it.

I learned that NSAIDs [Nonsteroidal anti-inflammatory drugs, such as aspirinibuprofen and naproxen] can suppress the release of melatonin―affecting one’s sleep. Once I stopped the baby aspirin, I began sleeping better.

Another decision is made, I told my cardiologist I was finished with taking Cardizem (120mg). I asked how I could safely stop it—did I need to wean off it or just stop cold turkey? He said, with a 120mg dose, cold turkey was fine. After I stopped taking the medicine, I was sleeping well.

A-Fib Episodes Every 4–6 Months

The A-Fib still hadn’t left. I had an episode every four to six months. My heart rate would go up to about 180 bpm and my heart felt like it was a fish trying to push through my chest.

I’d call 911 aach time and they’d come and either hook me up with Cardizem in my kitchen or in the ambulance to slow my heart rate. Then, while at the ER, my A-Fib would convert on its own.

The medicine they gave me never helped my heart rhythm―only heart rate. My heart rhythm would convert from A-Fib to sinus on its own.

My Pastors Pray for My Healing

As I shared before, being a Christian and believing what God says in the Bible about what He can do―I asked my pastors to anoint me with oil and pray over me for healing―as laid out in the book of James. They did that, and I did not have another A-Fib episode for 15 months.

I asked my pastors to anoint me with oil and pray over me for healing―as laid out in the book of James.

God touched me and stayed the A-Fib for that amount of time.

God’s Timing: Considers CryoAblation

After 15 months I had another A-Fib episode. This was around the beginning of 2013. At that point my cardiologist recommended I consider the CryoAblation.

Now that I look back on the timing of things, I think God chose to get me through the 15 months so more advancements could be made on the CryoAblation procedure for it to be safe for me to have it performed. He has His own reasons for sometimes miraculously and permanently healing some―and not permanently healing others.

I read about the CryoAblation procedure―mostly on StopA-Fib.org. The statistics proved good success rates and low risk―besides the obvious of it being invasive―and involving the heart.

Choosing an EP: High-Volume=Lower Complications

I had read that cardiologists/EPs who perform Cryoablations regularly [20 to 50 ablations/year] had increased safety statistically than compared to the ones who performed only a few. Well, it turned out my EP had performed 50 of them before mine. So, that made me feel a lot more comfortable! [See our article: Catheter Ablation: Complications Highest With Low-Volume Doctors]

So, in mid 2013 I had a CryoAblation for my A-Fib. And, I’m happy to say that the ablation was successful. I have not had an episode of A-Fib since!

I’m A-Fib Free! But Now Persistent PVCs

Life has been uneventful heart-wise until recently.

I have had persistent PVCs for a few months now. I basically have them 24/7…sometimes minutes apart sometimes seconds apart―but I don’t have any side effects except an occasional slight flush feeling in the face, but that’s it.

Testing for Magnesium Deficiency

Magnesium for Atrial Fibrllation patientsAfter some research online, it seems like magnesium deficiency would be something to investigate first. But the common blood serum test [Red Blood Cell Count (RBC)] to determine magnesium levels is unreliable (your body works to keep your blood serum levels consistent or your heart would stop).

What you want tested is your intracellular level of magnesium―which the Exatest [Energy Dispersive X-Ray Analysis] measures. That test is performed by a lab in California named Intracellular Diagnostics. I had that test done, and my intracellular Mg level was 34 while the lowest number within “normal” is 32. [See: Serum vs Intracellular Magnesium Levels]

But, according to an article on livingwithatrialfibrillation.com, Travis’ doctor says that “normal” can be different per person. So, although I’m within the defined “normal” range…maybe my personal normal is 36 or 38 or something.

Electrolytes in Normal Range—But Not Magnesium

Available at Amazon.com and other retailers.

For what it’s worth, the majority of my other electrolytes within the test were spot on in the middle of the “normal” range―while Mg was not. So, I’m taking that as meaning I may be Mg deficient.

So, I have been taking Natural Rhythm’s Triple Calm Magnesium with three types of chelated magnesium. I’ve read it takes a while to raise your intracellular levels of Mg, so it will take time to see if this works or not.

Also, for what it’s worth―my PVCs seem to be affected by the vagus nerve. Sometimes sitting down seems to magnify the PVCs. They also seem more pronounced after heavier meals sometimes. This is an interesting 2011 article about the vagus nerve and PVCs.

Asks God for Guidance

I’ll continue to try what I can, and ask God for guidance all the while. After all, He made the heart! Too bad that in this fallen world it’s susceptible to malfunctioning at times―partly due to it simply being a fallen world and partly because we don’t follow His ways that are designed to keep us from disease.

I’ll hold onto His promise that says:

“And we know that all things work together for good to those who love God, to those who are called according to His purpose.” (Romans 8:28, NKJV)

AGL, ayatingl@gmail.com

Editor’s Comments:
Magnesium Deficiency: Congratulations to AGL for investigating his magnesium level and going beyond the common blood serum test to measure his intracellular level of magnesium.
If you have A-Fib, it’s safe to assume you are magnesium deficient. Most everyone with A-Fib is. Magnesium has been depleted from the soil by industrial scale farming. It’s hard to get enough magnesium from today’s food.
Consider taking magnesium supplements. It takes about 6 months of taking magnesium supplements to build up healthy Mg levels. For more about A-Fib and Magnesium Deficiency, see our articles:
• Cardiovascular Benefits of Magnesium: Insights for Atrial Fibrillation Patients
• Mineral Deficiencies/Magnesium
• Low Serum Magnesium Linked with Atrial Fibrillation
PVCs and PACs (Extra Beats): PVCs (Premature Ventricular Contractions) and PACs (Premature Atrial Contractions) are often considered benign. Everybody gets them occasionally, not just people with A-Fib. But A-Fibbers seem to have more problems with extra beats than healthy people. After a successful A-Fib ablation, patients seem to have more extra beats. But, unlike in AGL’s case, they usually diminish over time as the heart heals and gets used to beating properly.
But the sources of PACs/PVCs signals can also be mapped and ablated just like A-Fib sginals. Also, beta blockers and antiarrhythmic drugs may help diminish those extra beats.
Catheter Ablation can make you A-Fib free: The options AGL’s cardiologist gave him in 2011 really weren’t equal.
• “Doing nothing”. This was impractical for AGL considering how badly A-Fib affected him, how often he had to call the paramedics and go to the ER.
• “Take Medications.” AGL tried Cardizem (a Calcium Channel blocker rate control drug), but it didn’t work for him. He might have tried various antiarrhythmic drugs, but their record isn’t good.
• “Ablation, but not recommended.” Though there is risk with any procedure, even AGL’s cardiologist eventually recommended he get an ablation in 2013.
An ablation is a low risk procedure with a high rate of success. Currently it’s the only option that offers hope of fixing one’s A-Fib and becoming A-Fib free.
A-Fib begets A-Fib: Atrial Fibrillation is a progressive disease. The longer you have it, the greater the risk of your A-Fib episodes becoming more frequent and longer. Over time this can lead to fibrosis making the heart stiff, less flexible and weak, reduce pumping efficiency and lead to other heart problems.
Don’t let your doctor leave you in A-Fib. Educate yourself. And always aim for a Cure! To learn more, read my editorial, Leaving the Patient in A-Fib—No! No! No!

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FAQs Understanding A-Fib: Options for Asymptomatic Longstanding Persistent A-Fib

 FAQs Understanding A-Fib: Asymptomatic Longstanding Persistent A-Fib

FAQs Understanding Your A-Fib A-Fib.com16. “I am 69 years old, in permanent A-Fib for 15 years, but non-symptomatic. My left atrium is over 55mm, and several cardioversions have failed. My EP won’t even try a catheter ablation. I exercise regularly and have met some self-imposed extreme goals. What more can I do?

As you already know, being in permanent (long-standing persistent) Atrial Fibrillation can cause other long term problems like fibrosis, increased risks of heart failure and dementia. So you are wise to be concerned.

I’m not surprised your electrophysiologist (EP) is reluctant about a catheter ablation. Being asymptomatic with 15 years of long-standing persistent A-Fib and a Left Atrium diameter of 55mm, most EPs wouldn’t recommend or perform a catheter ablation on you.

Drug Therapy Option: Tikosyn

Tikosyn (dofetilide) for long-standing persistent atrial fibrillation at A-Fib.com

Tikosyn (dofetilide)

Have you tried the newer antiarrhythmic drug Tikosyn (generic name dofetilide)?

Tikosyn was designed for cases like yours. It’s a Class 1A drug that works by blocking the activity of certain electrical signals in the heart that can cause an irregular heartbeat.

The only inconvenience of Tikosyn drug therapy is you have to be in a hospital for 3 days for observation and to get the dosage right.

Benefits of Activity and Exercise on Your A-Fib

You are truly blessed to be so active and without noticeable symptoms in spite of being in A-Fib. While exercise will not reduce the size of your LA, your activity level may compensate for the lack of pumping of your left atrium. In fact, your ventricles may be acting kind of like a turkey baster sucking blood down from your non-functioning LA before pushing blood out to the rest of your body.

Catheter Ablation and Surgical Options

Catheter ablation: Studies of non-paroxysmal A-Fib have shown that a successful catheter ablation can significantly reduce atrial dilation and improve ejection fraction. But, with your A-Fib being persistent long-standing, this may not apply.

Surgery: A Cox Maze IV surgery may reduce the volume and size of your left atrium while hopefully making you A-Fib free, but surgeons may be reluctant to tackle your case since the success rate is under 80%. A Cox Radial Maze is open heart surgery which is very traumatic and risky. It may be hard to justify open heart surgery if you’re asymptomatic.

My Recommendations

1. If you haven’t tried it yet, ask your EP about taking the newer antiarrhythmic drug Tikosyn.

2. If you’ve tried Tikosyn and it doesn’t help you, I recommend you consult an EP who specializes in longstanding persistent A-Fib. See Steve’s Lists. You may need to travel, but it may be worth it to you for your peace of mind. Also, ask the EP if surgery may be a helpful option.

3. Based on the results of the EP consult, I’d seek the opinion of a cardiac surgeon who performs the Cox Maze IV surgery. (See Steve’s Lists of surgeons who treat A-Fib patients.)

Making an Informed Choice

Armed with the above information you will be able to determine how you want to proceed. This is a decision only you can make.

With no A-Fib symptoms and a fulfilled life with plenty of body and soul enriching exercise, you may decide you are content with your present A-Fib status.

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New A-Fib Story: Frustrated, Crosses Canadian Border for Treatment

Rani and Moni Minhas

Rani and Moni Minhas

Our newest personal A-Fib story is told by a Canadian about his wife, Rani, who’s first symptom was feeling dizzy when checking in for a flight from Barbados. Over the next many months, she developed palpitations and A-Fib.

“Rani had fatigue and didn’t feel right. Before this, she was always healthy. She continued to exercise, as much as she could. But A-Fib really bothered her and made her feel both sick and anxious. Our whole family was worried about her.
Under the Canadian nationalized health care system, it took a lot of proactive action and aggressive approach to get proper help (which in the end wasn’t the proper treatment).
Almost every time we went to a doctor or a specialist, none of them had properly reviewed her file before they walked in to talk to her. It was pathetic. And we went to 4 cardiologists and 2 doctors.”

Frustrated for his wife, Moni turned to his friend, Google, and searched the web for information about Atrial Fibrillation. Read what Moni discovered and learn why they decided to cross the Canadian border to seek treatment in the U.S. …Continue reading…

Urinary Tract Infection Leads to Persistent A-Fib Followed by Two Failed Cardioversions

A-Fib Patient Story #91

Urinary Tract Infection Leads to Persistent A-Fib Followed by Two Failed Cardioversions

by Joe Kempin, October 2016

Sharon & Joe Kempin

Sharon & Joe Kempin

I am 64 years old and live in Fairfax, VA. In January 2016, I was afflicted with a pronounced arrhythmia. I could feel it often. I had a stress test done and a sonogram of my heart. All were good, but they could see I was going in and out of A-Fib.

In early March, I got very sick with a urinary tract infection and a 104° temperature. I could not eat and was in constant A-Fib. After I got well with antibiotics, I stayed in A-Fib.

We tried Cardioversions twice. Each one took me out of A-Fib for 3 days, but then right back into it. I was on blood thinners (Eliquis) then.

Experience of a Lifetime: Ablation at Fairfax Hospital

On May 18 I had an ablation. Wheeling me into the operating room was an experience of a lifetime. This was a brand new hospital building at Fairfax Hospital. The operating room was right out of Star Trek. Huge! The operating table was skinny with 8 people standing around it as I climbed on. None of them were doctors.

This was a brand new hospital building at Fairfax Hospital. The operating room was right out of Star Trek. Huge!

I wasn’t nervous, but for some reason I was feeling VERY sick. I don’t know why. They all got very busy on me. There were 2 computer cubicles off to the side, stainless steel machines hanging from the ceiling, and a floating lap top. IT WAS AMAZING!

It all went well, out of A-Fib. My doctor was Dr. Haroon Rashid at Virginia Heart. He was very good.

Minor Bleeding Complication Post Ablation

During the ablation, they had inserted 2 catheters into veins in my left and right groins. But that night one hole started to bleed. That’s a big problem. They patched it up REAL QUICK. But I could not move for 8 hours total. <!–more.

There was no pain involved after the ablation. But my heart felt like it was bound up with rope, like it was a loose jellyfish before but now it felt tightened up with a rock sitting on the top of it, but not painful, just there. I was still able to go home the next morning.

Recovering Back Home

I had gone to the gym regularly, about 3 times a week for years. After a few weeks, I was able to try that again but really couldn’t do much and then was exhausted for the rest of the day. I was on Eliquis and Multaq. I got short of breath very quickly. This was true for 2½ months. I came off of Multaq, then felt somewhat better, and at 3 months came off Eliquis and felt much better.

I came off of Multaq, then felt somewhat better, and at 3 months came off Eliquis and felt much better.

I had A-Fib 2 weeks after the ablation for 2 days and then again after 6 weeks for a few hours. [This is common during the 3 month ‘blanking ‘period’.] I am at now 4 months post-ablation. I occasionally go into A-Fib for a few hours now, but feel good. Only taking aspirin now.

There is an App for your smartphone called Kardia by AliveCor that can tell you when you are in A-Fib. [See our review of the AliveCor Kardia by Travis Von Slooten]

Lessons Learned

Lessons Learned graphic with hands 400 pix sq at 300 resDon’t worry about having an ablation. The operating room is an amazing experience, and there is no pain. The ablation procedure is very successful.

It won’t feel like you had a serious operation, but you did. It may take months to get back to feeling like yourself. You may feel a large loss of energy and need to sleep a lot. Plan on resting a good deal. 5 months since the ablation, I have only about half the energy I had last year at this time. Do the ablation right away.

Life and your abilities can change overnight. Get done what you want to do. Finish that bucket list.

Joe Kempin
Fairfax, VA

Editor’s Comments:
Joe didn’t mess around. With persistent A-Fib he wanted results. When 2 cardioversions failed after a few days (most patients’ A-Fib returns in a week to a month), he didn’t waste time with six-months to a year of drug therapies. Just four months after his diagnosis, Joe opted for a catheter ablation. Good for you, Joe!
Is Joe’s ablation a success? Even though Joe still experiences occasional A-Fib episodes, he feels much better than when he was in Chronic A-Fib. His ablation was for him a success and greatly improved his quality of life.
Because of having been in persistent A-Fib and because he may have had paroxysmal (occasional) A-Fib for years, he was probably a more difficult case. If Joe wants to be completely A-Fib free, he may have to return for a second touch-up ablation which has a higher success rate. Rather than having to do a complete Pulmonary Vein Isolation procedure, the EP during a second ablation usually only has to isolate a few A-Fib producing spots or gaps to make Joe A-Fib free.
Why shortness of breath and loss of energy? It’s unusual to feel shortness of breath for as long as 2½ months after an ablation, as Joe did. It’s hard to speculate what may have caused that shortness of breath. Perhaps it was the medications. The bottom line is Joe feels OK now and is back exercising at the gym and living a normal life.
Most people after a successful ablation feel more energetic or at least as energetic than before they developed A-Fib, because their heart is pumping normally. We don’t know why Joe is experiencing a loss of energy. It may be because he still has occasional A-Fib episodes.
I am concerned about his low energy level. Joe should continue to discuss this with his doctor. Together they may find a solution to getting his pre-ablation energy back.

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Frustrated, Crosses Canadian Border for Ablation by Dr. Andrea Natale in Austin, TX

A-Fib Patient Story #90

Frustrated, Crosses Canadian Border for Ablation by Dr. Andrea Natale in Austin, TX

By Moni Minhas, Calgary, Alberta, Canada, October 2016

Rani and Moni Minhas

Rani and Moni Minhas

My wife, Rani Minhas, developed A-Fib in January 2015 when she was 61 years old. She felt dizzy when we were checking in for a flight from Barbados. She got better that day, and we took a later flight.

Over the next many months, she developed palpitations and A-Fib. We did not know it was A-Fib as we had never heard of the term.

“Get Used to It (A-Fib)…and It Will Get Worse.” NO! NO! NO!

Rani had fatigue and didn’t feel right. Before this, she was always healthy. She continued to exercise, as much as she could. But A-Fib really bothered her and made her feel both sick and anxious. Our whole family was worried about her.

Under the Canadian nationalized health care system, it took a lot of proactive action and aggressive approach to get proper help (which in the end wasn’t the proper treatment).

What is a normal BP reading? Less than 120/80 mm Hg (<120 systolic AND <80 diastolic).

The first cardiologist suggested Rani start taking a blood thinner and dismissed A-Fib as something that “happens when you get old, get used to it; and it will get worse.”

He did not even prescribe beta blockers. Instead, he suggested a Blood Pressure medicine. Her BP that day was 165/90.

After waiting for weeks, we went to cardiologist #2. He prescribed beta blockers and recommended Rani take a higher dosage when she felt palpitations [known as pill-in-the-pocket drug therapy].

Note: Almost every time we went to a doctor or a specialist, none of them had properly reviewed her file before they walked in to talk to her. It was pathetic. And we went to 4 cardiologists and 2 doctors.

Frustrated! Searches Web and Finds the A-Fib Coach Steve Ryan

Frustrated, one day, I turned to my friend “Google” and found The A-Fib Coach. I contacted Steve Ryan and paid the small fee he charges [for one-to-one coaching]. Then I ordered the Beat Your A-Fib book he has written. I never read the book as it seemed scary to read (not the book but the symptoms and consequences of A-Fib!).

Her first doctor: “A-Fib is something that happens when you get old, get used to it; and it will get worse.”

Steve was wonderful to talk to and told me about the Catheter Ablation procedure and gave me a lot of background on it and its benefits and risks, which were not many in my wife’s case.

Consultation with Dr. Thometz in Billings, Montana

I now went back to my friend “Google” and looked for an expert in Catheter Ablation close to our home in Calgary (Alberta Canada). Acrosss the U.S. border, I found someone in Billings, Montana. I made an appointment, and Rani and I drove 8 hours to Billings and stayed a night in the hotel.

The next morning, we spoke for 2 hours with Dr. Alan Thometz, the cardiac Electrophysiologist (EP) in Billings Clinic. He was very knowledgeable and helpful and answered every question we had. (We had a lot of help from Steve Ryan as to what questions to ask.)

We were comfortable with Dr. Thometz doing the procedure, but there was an 8 week wait. And Steve Ryan did not know him personally, which was not critical but was of some importance in deciding.

Let’s Find the Best EP in the USA

I asked Steve Ryan to suggest the best EP Cardiologist in the USA. He recommended Dr. Andrea Natale from Austin TX and Dr. Vivek Reddy in NY. We got an appointment with Dr. Natale quickly and in early June 2016 went for a catheter ablation procedure.

Ablation by Dr. Natale―No More Palpitations, No More A-Fib!

Dr Andrea Natale

Dr A. Natale

Dr. Natale did the procedure which took half a day. Rani stayed in the hospital overnight. Right after the procedure, we stayed in a hotel for another 10 days, even though it was not required. But I wanted Rani to be comfortable before coming home.

The procedure was great. No more A-Fib, no more palpitations. And no more beta blockers.

Recovery Period: 3 to 6 Months

We were told there is a 3 to 6 month recovery period [blanking period) for the heart to heal. Rani did have a few days of high BP and 1 day of low BP while her heart was healing. This is almost all gone, and she has 120 BP now on a regular basis which is perfect.

It has now been over 4 months, and Rani is now jogging and exercising every day. She does get some fatigue, but we feel pretty good that she will get over that by January 2017 based on trends. For now, she takes BP medicine and a blood thinner (Xarelto).

Gratitude to Steve Ryan

To say Steve Ryan was extremely helpful is an understatement. Without his guidance, we would not have known that Catheter Ablation is an option. Without him, we would not have found Dr. Natale. We haven’t met Steve Ryan in person, but the next time we’re in Los Angeles, we’ll take him out for dinner as a way of thanks.

Lessons Learned

Lessons Learned graphic with hands 400 pix sq at 300 resGood health is the best gift we can have. If you have A-Fib (or any health issues), be aggressive and proactive in seeking treatment and advice.

Do not assume every healthcare professional is doing their job, including doctors and cardiologists. Use your own judgement and ask a lot of questions. Challenge the medical staff.

Moni Minhas
minhas@minhasbrewery.com

Editor’s Comments:
Be Proactive! Moni and Rani’s story is an excellent example of being proactive rather than passively living with A-Fib for the rest of her life.
I’m astounded that any doctor today would tell Rani and Moni to just live in A-Fib, “get used to…and it will get worse.”
Moni knew something was wrong with this doctor’s advice. He educated himself about A-Fib. He got second (and third) opinions. He didn’t let his beloved wife, Rani, suffer from A-Fib. He found the best doctor he could and got her treated and cured before her A-Fib could get worse. Her quick treatment may have made her A-Fib much easier to cure.
Long-Term Effects of Living in A-Fib: Aside from feeling miserable, having a reduced quality of life, and suffering emotional stress and anxiety, over time A-Fib can have devastating effects on your heart, brain and other organs.
Don’t Live in A-Fib! Follow Moni and Rani’s example! Don’t listen to doctors and others who may tell you that A-Fib can’t be cured, that the only thing possible is to improve A-Fib symptoms; or that catheter ablation is experimental and not proven; or that you have to take these A-Fib drugs for the rest of your life and you should just learn to live with A-Fib.
Instead, RUN, don’t walk to get a second opinion (and even a third)!
Compared to other heart ailments, A-Fib is relatively easy to fix. You owe it to yourself to get the facts, to look at all your treatment options, not just drugs.

You don’t have to live in A-Fib!

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If you find any errors on this page, email us. Y Last updated: Tuesday, February 7, 2017

Clinical Study Findings: CryoBalloon Better Than RF Ablation?

We can now say that CryoBalloon ablation is better than RF, at least according to a secondary analysis of a recent clinical study.

In the FIRE AND ICE clinical trial by Dr. Karl-Heinz Kuck and his colleagues, 762 patients with symptomatic paroxysmal A-Fib were randomized into two groups, either RF catheter ablation or CryoBalloon ablation.

Results: Many findings were comparable. Both groups had similar results in terms of primary efficacy and safety endpoints. Furthermore, both groups had improvement in quality of life over 30 months of follow-up.

Where Results Diverged: Re-Hospitalization and Recurrence

While many of the outcomes were similar between the two groups, there were some significant differences. The CryoBalloon group had lower rates of re-hospitalization (32% with CryoBalloon versus 41.5% with RF catheter ablation). In addition, the CryoBalloon patients had fewer:

• Cardiovascular re-hospitalizations (23.8% vs 35.9%)
• Repeat ablations (11.8% vs 17.6%)
• Direct current cardioversions (3.2% vs 6.4%)

Karl-Heinz Kuck, MD portrait at A-Fib.com

KH Kuck, MD

According to lead researcher, Dr. Kuck:

“The secondary analysis (of the FIRE AND ICE study) favors CryoBalloon over (RF ablation), with important implications [for EPs] on daily clinical practice.”

Dr. Wilber Su of Banner-University Medical Center in Phoenix, who was not part of this FIRE AND ICE study, concluded:

Dr Wilber Su at A-Fib.com

Dr Wilber Su

“…for most operators, CryoBalloon may be a safer and more efficient approach… . In my practice, CryoBalloon has already become the preferred approach both from personal experience as well as patient demand.”

What Patients Need to Know

Which ablation procedure is better—RF or CryoBalloon? According to the FIRE AND ICE clinical trial, we can now say that CryoBalloon is better in terms of less re-hospitalizations, repeat ablations and recurrences within a 30 month period.

More important than the energy source used to perform the ablation, is the skill and experience of the operator (EP).

Don’t Avoid RF: In practical terms, the differences weren’t so great that you should avoid EPs who prefer to use RF.

Dr. Su points out that many electrophysiologists (EPs) may continue with RF ablation because being comfortable with their choice of technology is a critical factor.

Look for Skill and Experience: More important than the energy source used to perform the ablation, is the skill and experience of the operator (EP).

The Bottom Line: When researching an EP to do your ablation, look for the best, most experienced high volume operator you can find and afford, even if you have to travel.

Caveat About CryoBalloon Ablation

CryoBalloon catheter

CryoBalloon catheter

CryoBalloon ablation is much easier and faster to do than RF point-by-point ablation. Consequently, some operators are entering the field with little RF ablation experience on which to build or complement their Cryo skills.

Others are doing only “anatomical ablation”—only ablating the pulmonary vein openings and not looking for and ablating non-PV triggers. (Happily in many cases, this is often all that is needed, particularly in cases of recent onset or Paroxysmal A-Fib.)

For more critical information about choosing your EP for a Cryoballoon Ablation, read my posts:

• Huge Growth in Number of EPs Doing Catheter Ablations
• CryoBalloon Ablation: Alarming O.R. Reports (Part I)
• CryoBalloon Ablation: All EPS Are Not Equal (Part II)

Resources for this article

 

New FAQ: Does Ablation Reduce Heart’s Pumping Volume?

Our new Frequently Asked Questions & Answers (FAQs) is about the heart’s blood pumping capacity after an ablation.

“I’m a life-long runner. I recently got intermittent A-Fib. Does ablation (whether RF or Cryo) affect the heart’s blood pumping output potential because of the destruction of cardiac tissue? And if so, how much? One doc said it does.”

As a fellow runner, I understand your concern on how an ablation might affect your ability to resume your athletic activities.

Lesions at PVs openings

Seek Your Cure: Keep in mind, with Atrial Fibrillation you lose 15% to 30% of your heart’s normal pumping volume along with lower oxygen levels. Your body and brain aren’t getting the blood and nourishment they need. An catheter ablation is an important way to improve or restore your heart’s pumping volume.

PVAI - Ccommon lesion set at A-Fib.com

More extensive lesions pattern

Ablate as Little Tissue as Possible: A common ablation technique for paroxysmal A-Fib (using RF or Cryo), ablates only around the opening of each Pulmonary Vein (PV) and isn’t likely to affect the heart’s output.

On the other hand, more extensive lesion patterns affecting more tissue may affect the heart’s output. For example, during a PV Wide Area Antrum Ablation, instead of just ablating around each of the PV openings, large, oval lesions are made in the left atrium encircling both the upper and lower vein openings.

My Best Advice to Runners with Atrial Fibrillation

For a runner, a more extensive ablation of the left atrium may affect heart output more than circular lesions of each vein opening. …Continue reading my answer…

In A-Fib for 15 Years, Eventually Unable to Work

Terry Traver' s story at A-Fib.com

Terry Traver’ s story

We’ve posted a new personal experience story. Terry Traver of Thousand Oaks, CA, shares his 15-year battle with A-Fib.

“For over 15 years I suffered with A-Fib. It was not so bad [at first]. I stopped using caffeine and chocolate and cut back on my [alcohol] drinking.

Every three months or so I would have an episode that would last about 15 hours and then I would be fine. Meds never really helped in my case.

A-Fib Progresses to Severe and Incapacitates

In 2011, my A-Fib became severe to the point where I was almost completely incapacitated [Persistent Atrial Fibrillation]. I was not even able to work. …Continue reading Terry’s story…

Top 10 List #1 Find the best EP your can afford - A-Fib.com

FAQs A-Fib Ablations: A Runner’s Heart After Ablation

 FAQs A-Fib Ablations: A Runner’s Heart 

Catheter ablation illustration at A-Fib.com

Catheter ablation

“I’m a life-long runner. I recently got intermittent A-Fib. Does ablation (whether RF or Cryo) affect the heart’s blood pumping output potential because of the destruction of cardiac tissue? And if so, how much? One doc said it does.”

As a fellow runner, I understand your concern on how an ablation might affect your ability to resume your athletic activities.

Seek Your Cure: Keep in mind, with Atrial Fibrillation you lose 15% to 30% of your heart’s normal pumping volume along with lower oxygen levels. Your body and brain aren’t getting the blood and nourishment they need. An catheter ablation is an important way to improve or restore your heart’s pumping volume.

Catheter Ablation Lesions around PV openings at A-Fib.com

Lesions around PV openings

Ablate as Little Tissue as Possible: A common ablation technique for paroxysmal A-Fib (using RF or Cryo), ablates only around the opening of each Pulmonary Vein (PV) and isn’t likely to affect the heart’s output.

On the other hand, more extensive lesion patterns affecting more tissue may affect the heart’s output. For example, during a PV Wide Area Antrum Ablation, instead of just ablating around each of the PV openings, large, oval lesions are made in the left atrium encircling both the upper and lower vein openings.

PVAI - Ccommon lesion set at A-Fib.com

More extensive lesion pattern

(This is intuitive on my part; we don’t have clinical studies confirming any effect or difference between the two approaches in terms of heart output and atrium function.)

For a runner, the more extensive ablation of the left atrium may affect heart output. Less active patients may not notice the difference, but a runner like you may.

My Best Advice to Runners with Atrial Fibrillation

Seek out the Best EPs: Select the most experienced Electrophysiologists (EPs) you can afford (and travel if you need to). Discuss catheter ablation and your concerns about decreased heart output after ablation. A good EP will make as few lesions during your ablation as possible.

Paroxysmal A-Fib Easiest to Ablate: At the moment you have “paroxysmal A-Fib of recent onset” and it’s usually the easiest to fix. It’s likely you will not need an extensive ablation. (Though one never knows till the actual ablation; Read what Travis Van Slooten wrote about how his “easy case” turned into a complex, extensive ablation.)

Ablate ASAP: Get your ablation as reasonably soon as possible, before your A-Fib has a chance to get worse and requires a more extensive ablation.

Keep your medical records in a binder or folder. at A-Fib.com

Keep A-Fib records in a binder or folder.

Monitor Progress of your A-Fib: A-Fib is a progressive disease. You should track if your heart’s measurements are getting better or worse, and by how much. Ask your doctor for the measurements of heart dimensions and its functions including the diameter and volume of the left atrium, your Ejection Fraction (EF) and any other test results.

Store all your test results and measurements in your A-Fib three-ring binder or file folder.

What Patients’ Need to Know: A progressively enlarging heart and a falling EF percentage (below 35%) means your A-Fib is worsening. To preserve your heart’s best functions, seek an ablation before your A-Fib worsens.

As a runner, even if your heart is somewhat enlarged and your EF has decreased, a successful catheter ablation may not only end your A-Fib and improve your Ejection Fraction but over time may even reduce your enlarged left atrium.

Thanks to Joe O’Flaherty for this question.

If you find any errors on this page, email us. Last updated: Thursday, February 9, 2017

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